Benefits Buzz

Getting a Higer Rx Mail Order Rate Takes a PhD in Behavioral Science...

Well - not really, but it might help. 

If you've been responsible for oversight of the medical spend in your company, than you know two things are true related to your Rx plan saving you money:

1.  You need aggressive formularies

2.  You need to max your generic penetration rate

3.  You  need to max your mail order penetration rate (for scripts that are available for mail order).

Not a lot of surprise there, and you're probably familiar with the fact that you can usually get some movement with a little internal PR, then you get to a plateau and get stuck.  What do you do then?

Express Scripts, a St. Louis pharmacy benefit manager that handles drug coverage for large employers and health plans, is out to change that result. The company is applying the principles of behavioral economics to reduce waste, improve patient health, and boost its bottom line.

Here's an example of a behavioral program at Express Scripts via Business Week:

"One example: More than 70 Express clients, including uniform supplier Cintas (CTAS), have signed up for an initiative that focuses on getting employees to order drugs for chronic conditions, such as high blood pressure, through the mail. Home delivery is more efficient and thus a higher-margin business for Express than managing prescriptions filled at drug stores. That's because mail-order prescriptions get processed through its highly-automated pharmacies and come in 90-day packs instead of the usual 30-day supply. At the beginning of a three-month program that Express piloted with Lowe's (LOW), only 14% of the home improvement retailer's employees on so-called maintenance medications received their drugs by mail. When the pilot ended in March, 38% did."

How did they do that that? 

"Express and rivals such as Medco (MHS) typically try to persuade patients to switch by making mail-order drugs cheaper than store-bought ones. (Some employers require mail order for certain medications.) But incentives don't always work. The reason, says Express Chief Scientist Bob Nease, is a phenomenon known as "present bias," one of the principles of behavioral economics, which stresses that humans often act irrationally. People are more inclined to focus on the immediate hassle of changing a habit than the future benefit. So faced with the paperwork to initiate home delivery, most will keep driving to a pharmacy.

Express attacked such inertia by forcing Lowe's employees to make a conscious choice. The company contacted employees with letters and phone calls, asking them to choose between mail and retail. If employees didn't make a decision by their third refill, their drug costs would not be covered until they decided. That forced customers to weigh their options. 

Another theory Express is using is "loss aversion," which says people work harder to avoid losses than to pursue gains. That has led it to change its marketing pitch in other programs from "save money" to "stop wasting money".

Note - the program sounds innovative and it is in many regards, but the "nuclear option" of mail order - leaving employees at the retail pharmacy without having the ability to fill a prescription - is in play here, which always leads to a nice spike in the mail order penetration rate.

Would you take that nuclear option?  More and more companies will in today costs environment...

Pfizer Program Helps Unemployed Maintain Access to Rx

There's no shortage of discussion about the risk of rising health care costs and tightening budgets discouraging people from taking important prescription drugs. It is a problem for both those with insurance (but high copays for brand name drugs) and those without insurance who can't fork out the cash for pricey prescriptions every month. And, it is a short-term personal budget fix that has awful long-term health implications (which, of course, means long-term health expenses too -- for the individual, their employer, really all of us).

So, this Pfizer program caught my eye. MAINTAIN is a program that lets unemployed individuals (and their families) who are in financial need and lack prescription coverage continue to get their Pfizer medicines free-of-charge for up to one year (or until they become insured, whichever comes first).

This is right from the official Pfizer info: 

Through MAINTAIN, more than 70 Pfizer medicines are offered that treat a range of chronic health conditions. It is easy to learn if you may be eligible, by visiting www.PfizerHelpfulAnswers.com or calling 866-706-2400. The program is user-friendly, with a one-page application that Pfizer will typically process within two to three weeks. The program is expected to accept applications through December 31, 2009.

There are four eligibility requirements for MAINTAIN:

• Applicants must be able to demonstrate loss of employment since January 1, 2009;
• Lack prescription coverage;
• Attest to financial need; and,
• Be on their Pfizer medicine for at least three months prior to unemployment and enrolling in the program.

Uninsured patients who need a Pfizer medicine but who do not qualify for MAINTAIN may qualify for Pfizer’s other Patient Assistance Programs.

No matter what you think of big pharma, you can't complain about this program. And, what I like even more is this nifty little tool on their website to help you find Assistance Programs that are right for you (available in Spanish too). Medical plans can be super confusing, and prescription drug programs are notorious for being anything but user friendly (my favorite being the all-too-common labels "preferred" and "non-preferred" for brand name drugs--usually the "non-preferred" is the higher copay, meaning "not preferred by your PBM--we don't really care about your perspective.")  So, it is really nice to see the extra step taken to make these programs accessible, not just out there for the good-guy status.

Also, I'm often asked what employers can do to "soften the blow" of layoffs. There's not really any way to make getting laid off seem like good news, but employers can provide departing employees with helpful resources like this program and other assistance programs. That's a simple step that shows real concern for your workforce--even after they leave. 

Editor's Note - Jennifer Benz is founder and chief strategist at Benz Communications, a boutique consulting firm that focuses on employee benefits communication.

People: Take Your Drugs, Please...

The big idea to control medical trend this year, and every year after that?  Get in shape?  Well... yeah, but let's start with something that isn't at the apex of behavior modification and for the most part, doesn't hurt.

Take your drugs people.  That the hundred billion dollar idea is what CVS CEO Tom Ryan is pushing. Before you get up on your soapbox about the overmedicated state of the United States, hear him out, please... (?)

More on the CVS dream from BusinessWeek:

"During his 15 years as CEO of CVS (CVS), Tom Ryan transformed the company from a New England drugstore chain into a national health-care colossus with $76.3 billion in annual sales. He did that through a string of major acquisitions, paying $27 billion for drug middleman Caremark in 2007 and $2.9 billion for West Coast regional chain Longs Drug Stores (LDG) last October.

CVS/Caremark is now one of the 20 biggest companies in America, surpassing Boeing (BA), Target (TGT), and Johnson & Johnson (JNJ). The Woonsocket (R.I.) outfit is the largest single buyer and dispenser of prescription drugs in the nation. The Longs deal extends the chain's retail presence from Maine to Hawaii, with nearly 7,000 stores and more than 50 million users of its CVS loyalty card in the U.S.

What does Ryan intend to do with his drugstore empire? His goal, he says, is to help transform America's expensive and often ineffective health-care system. Seeking to take advantage of President Barack Obama's commitment to health-care reform, Ryan wants to use CVS's vast prescription database and burgeoning network of in-store clinics to treat patients with chronic diseases and help keep them out of the hospital, where most medical costs are incurred. "I don't think our health-care system is broken," Ryan says. "We are just spending too much, and it's unproductive."

Few industry experts would argue. Hospital visits prompted by chronic illnesses such as diabetes, heart disease, and arthritis impose an immense burden on health resources in the U.S. The total annual bill for diabetes alone is upwards of $170 billion, according to the American Diabetes Assn. Many of these costs would evaporate if patients simply complied with their doctors' orders and took their medications. In fact, about one-third of all patients who begin a drug regimen never refill the prescription, either because they don't feel sick, they forget, or they don't want to spend the money.

Ryan believes CVS could help solve this problem and, in the process, boost its own bottom line. As a pharmacy benefit management company, the Caremark unit handles drug coverage for large employers and health plans, negotiating discounts with drugmakers. It owns a treasure trove of prescription drug data, as does CVS. The merged company is thus an info tech Goliath, filling or managing more than a billion prescriptions a year. It can use that information to figure out which customers require a gentle reminder to come in for a refill."

The key issue here is privacy, how hard the nudge can be, and what the penalty could be if people don't follow the drug regiments. 

So we have Billions on the table that can be captured by allowing hard nudges?  I'm for it, but only if we're willing to withdraw funding or coverage who don't do what they need to do.

Overdosed America - Taking On The Health Care Crisis One Step At A Time

I work for a Veteran's Health Research organization so naturally we get November 11th off each year as a holiday. Not so for me this year. Instead I attended a "Wells Fargo Health Solutions Seminar with Dr. John Abramson".

I wasn't sure what to expect as the title was a little vague and I hadn't yet heard of Dr. A. All I knew is that our broker at ABD kept saying what a great event this was going to be. I had no idea I would come away all fired up and politicized, ready to demand my rights as a consumer and take on the entire Health Care Crisis singlehandedly.

...Let me explain...

In 2004 Dr. Abramson wrote a book called "Overdo$ed America The Broken Promise Of American Medicine--How The Pharmaceutical Companies Are Corrupting Science, Misleading Doctors, And Threatening Your Health (And up in the left hand corner there is a little balloon that says "The Truth About Vioxx, Celebrex, Statins, and More). OK, that's all you need to know--end of POST--just READ THE BOOK... In it he totally busts Big Pharma and a lot of the so-called research findings that come out of studies funded by Pharmaceutical companies. I know this isn't necessarily news to many of us, however the facts and statistics he lays out, and analysis he uses to derive his conclusions are very compelling. In person he is an impassioned speaker on behalf of reasonable, sane, effective health-care reform. Do away with the expensive drugs and procedures as routine, matter of course

From the book, pg 209-210...

"Pretending to care about our health is often just part of the drug and other medical industries' overall strategy to increase their sales. They dominate the medical journals, airwaves, newspapers, and magazines with "information" designed to convince doctors and patients that their products are essential for good health. They focus attention on the health problems and solutions that are the most commercially advantageous rather than most beneficial for our health." ...

"The truth, as we have seen, is that the benefits of medical care are real but limited, and more is not always better, and is often worse. These awkward facts get shoved into the background of our common wisdom buy the bright lights of advertising and medical news that shine incessantly on the "breakthroughs" in medical progress and the drugs you should "talk to your doctor about." By saturating our sources of information, the medical industry has convinced most Americans that the answer to almost every health problem can be found in a brand-name pill or high-priced medical procedure.

That's the bad news. And it's very bad, costing Americans hundreds of billions of dollars a year, and even worse, compromising our health and quality of life. But there is good news too--and it's enormously good: the evidence from study after study, including gold-standard randomized clinical trials, shows that we can usually do a great deal more to maintain our own health than the medical industry, particularly the drug industry, promises it can do for us."

In subsequent posts I'll discuss what Dr. Abramson suggests we can we can do, from the inside, as Benefits Professionals, to begin to make an impact and change how things are now to how they could possibly be in the future.

Editor's Note - Joan Gibson is a Benefits Analyst for NCIRE, which is the non-profit organization charted by congress back in the 80's to manage all the government funding/grants/contracts for the medical research projects happening at the SF VA Medical Center.  When she's not attending a conference, you'll find her on the phone trying to squeeze usage stats out of unsuspecting targets like the NCIRE EAP vendor....

Pharma Rep Playbook - 4 Minutes with Doctors = 52% Jump in Scripts Written...

I want all of our employees to have the medical care they need.  Let's start there before anyone brands me as a fiscal hawk looking at numbers rather than employee well-being...

If there's one area of Medical care that drives me crazy, it's got to be big Pharma vs. doctors, patients, and yes, your local company medical plan. 

Big Pharma gets paid off of blockbuster drugs that they hold exclusive rights to.  That part of the system I get, since there are development costs tied to the R&D effort.  It's the repackaging of brand name drugs, once generics are available, that drives me crazy.  Hey, why take that generic every day?  We've just revamped the brand name equivalent with enough potency to last 5 days.   Uh, yeah... It'll cost your medical plan $1,000 more per year, but who cares?  Your employee contribution is the same regardless.

In case you needed more examples of the power of the Pharmaceutical Rep over most doctors, consider this article in a recent BusinessWeek entitled "Just Say No to Drug Reps":

"Dr. Adriane Ugh-Beman wishes more doctors would greet marketing pitches from drug companies with skepticism. So she is taking her message to medical schools. An associate professor of physiology and biophysics at Georgetown University, she has spent the past six months lecturing med students at Georgetown and neighboring schools on how to resist sales reps' overtures, such as doling out free drug samples to physicians and bringing lunches for office staff.

Often, the audience starts out belligerent, Ugh-Beman says, protesting that they're "too smart to be bought by a slice of pizza." But that changes when "we correct them with the numbers," she says. A doctor who spends just one minute with a sales rep typically ends up prescribing 16% more of that rep's product than he or she was prescribing before. And a four-minute encounter is likely to prompt a 52% jump in prescriptions, says Ugh-Beman."

I didn't dig around on the net for the white-paper behind Ugh-Berman's claims, but I am assuming if it made BW, it's legit research.

Let's assume programs like this can prepare doctors for the drug rep pushing product.  No sweat to Big Pharma, because they've got an even more powerful marketing tool.   It's called the demands of their patients after watching 20 Pharma ads every night during American Idol... What's a busy M.D supposed to do when someone brings him an ad for Paxil during a routine visit?  Prescribe (gasp) exercise? 

Every seen a Viagra ad?   All they have to do is create a market with a couple of Billion dollars worth of ads, and all of a sudden the pressure is on to pick up the full tab for each new class of drugs that's introduced... 

Man, am I tired of scrambling for the remote during a basketball game on the weekend or during prime time when the Viagra ads come on (hello? kids are watching when these things run!).  But those guys throwing the football sure are accurate throwing it through that tire in the back yard... 

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